Constantine the African and the Qayrawani doctors: Contribution of the ‘Phoenicians’ of North Africa to Latin Medicine in the Middle Ages and Renaissance

When a sixteenth-century medical writer referred to Phoenicians, alongside Arabs, as exceptionally important medical sources, he was probably referring to the Muslim and Jewish doctors of Qayrawan, who were writing in Arabic in the tenth century, and Constantine the African, who was translating their writings into Latin in the late eleventh century. The resultant corpus of medical works, transmitted initially from the Benedictine monastery of Montecassino, formed the core of medical education in the West, and continued to be influential into the Renaissance.

Article Banner: An early illustrated work dealing with the school of Salerno. The cover shows Constantine the African lecturing to the school. From Anastasiuset al., Regimen sanitatis Salernitanum (Source)

On the title page of a medical work published in Lyons in 1517 we read:

‘The New Practice (of medicine) of the Lyonais compiler, Lord Symphorien Champier, concerning all the kinds of diseases, <compiled> from the traditions of the Greeks, the Latins, the Arabs, the Phoenicians, and recent authors, <in> five golden books.’[1]

In the preface Symphorien Champier refers to the ‘Arabs and Phoenicians, as the most serious and brilliant interpreters <of medicine>’ (fol. 3v: ‘Arabes vero et Penos velut gravissimos splendidissimosque interpretes’), and on a typical page, from book four, we read the heading ‘From the tradition of the Phoenicians and the Arabs’ (fol. 86r: ‘Ex traditione Penorum et Arabum’; Figure 1). The Arabs and Phoenicians are also mentioned in other works of Symphorien Champier, such as in his preface to De curatione pleuritidis per venae sectionem autore Andrea Turino (‘On the cure of pleuresis through bloodletting, by Andrea Turino’), published in Basel in 1537, where we have the phrase ‘Andrea has the support of all the Arabs and Phoenicians’ (sig. a2 verso: ‘Habet et Andreas secum Arabes et Pœnos omnes’).

Symphorien Champier (1471-1539) was a prolific humanist and doctor, who spent his career in Lyons, and wavered between attacking the science of the Arabs and embracing it.[2] Using the Classical adjective ‘Peni/Poeni’ he is referring to the Phoenicians, who wielded power over the Western Mediterranean from their base in Carthage from the ninth to the third century BCE. But it is not these ancient Phoenicians that Symphorien has in mind. The quotations attributed to them turn out to be from the works of Isaac Isra’ili and his translator Constantine the African. Since they both from the area formerly under control of the Phoenicians—Ifriqiya, roughly equivalent in area to modern Tunisia—he can honour them with the Classical title of ‘Phoenician’.

We know about the life of Constantine only from Western sources (mainly Peter the Deacon and a certain ‘Matthew F.’).[3] These, naturally, are much vaguer about his life before he suddenly appeared at Salerno, the leading medical school in the West. He is said to have been born in ‘Carthago’ (‘Carthage’). He then travelled throughout the known world (Babylonia, India, Ethiopia and Egypt) in pursuit of knowledge. But on his return home he was persecuted by the ‘Afri’ (‘Africans’), and ‘secretly fled to Salerno’, where he found the state of medical learning so poor in comparison with what he knew in his native land, that he immediately returned home and collected a number of Arabic manuscripts on medicine, intent on bringing them to Salerno to improve the standards there. Unfortunately, he suffered shipwreck on Cape Palinuro, and staggered into Salerno with only half his manuscripts. This account probably deliberately recalls Aeneas’s own journey from Carthage to Italy (after the episode with Dido), and the drowning of his oarsman Palinurus, after which the cape took its name.[4]

The story from here on is somewhat clearer, since we are now on the same soil as the biographers, and backed up by contemporary documents. He was in Salerno by 1077, but in 1078 he entered the Benedictine Abbey of Montecassino (the mother house of the Benedictine Order), as a monk. His entry coincided with the splendid revival of the abbey under Abbot Desiderius (1058–1086), who later became Pope Victor III (1086-7). Desiderius’s Montecassino was a centre for Greek learning as well as Arabic. The Abbey had its own infirmary where certain monks performed the role of doctors and nurses. But even more so, it had its own scriptorium, where texts were copied and illustrated. This was the gateway through which Arabic medicine first entered Europe. Constantine died there in the very last years of the eleventh century. He was always known as the African (sometimes with the addition ‘monk of Montecassino’).

But how much faith can we put in the story that he originated from Carthage? In the mid-eleventh century Carthage was a ruin. After the Romans sacked the Phoenician city, it re-emerged as a Roman city, the capital of Africa Proconsularis, which coincided with the borders of modern Tunisia, with an extension along the coast eastwards. As such it survived into the Christian era. It was the capital of the exarchate of Africa, an administrative division of the Byzantine Empire encompassing its possessions in the Western Mediterranean, and ruled by an exarch (viceroy). The exarchate was created by Emperor Maurice in the late 580s and survived until the Muslim conquest of the Maghreb in the late seventh century. Carthage was destroyed in 698, but it was still possible to speak of a ‘bishop of Carthage’. Pope Leo IX (1049-54) urged African bishops in 1053 to support the archbishop of Carthage, who ‘presided over the entire African church, and was second only to the Pope’.[5]The name ‘Carthage’ harked back to the Classical city, but, in fact, by this time, what had been left of ancient Carthage was subsumed into the area of the newly emerging Arabic city of Tunis, which started to rise to prominence as the chief city of the Arabic region of Ifriqiya in 1059. This is the very time that Constantine might have been in this region, and thus, with some justification (and maintaining the ‘Classicizing’ language of Latin humanists), he could be called a ‘Poenus’.

In all likelihood Constantine belonged to a Christian community in Africia/Ifrikiya–even a community that still had some knowledge of Latin.[6] It is unclear for how long Romance continued to be spoken, but its influence on North African Arabic (particularly in the language of northwestern Morocco) indicates it must have had a significant presence in the early years after the Arab conquest. In the twelfth century the geographer al-Idrisi, describing Gafsa in southern Tunisia, writes that ‘its inhabitants are Berberised, and most of them speak the African Latin tongue (al-laṭīnī al-ifrīqī)’.[7] Calques like dura mater, pia mater for the two meninges covering the brain—al-umm al-jāfiya and al-umm al-raqīqa—might suggest the native knowledge of Latin or ‘African Romance’.

But Constantine was not Champier’s only Poenus. He also mentions ‘Isaac’. In this he is referring to the chief Arabic author whose works Constantine translated. In fact, Constantine relied on the works of three authors, who were related as a succession of master and pupil: Isḥaq ibn ‘Imran (d. ca. 903-9), his pupil Isḥaq al-Isra’ili (who died in the mid-tenth century, Champier’s ‘Isaac’) and Isḥaq’s pupil Abu Ja‘far ibn al-Jazzar (who died in 980). These doctors all lived and worked in al-Qayrawan, 184 kilometers south of Tunis and the most important city in Ifriqiya before the rise of Tunis. In 800 the Aghlabids made al-Qayrawan their capital and there followed a period of prosperity and cultural flowering. The Shi’ite Fatimids arose in Ifriqiya and, replacing the Aghlabids in 909, spread over the whole of the North African coast, making Cairo their capital. But the Zirids were their vassals in al-Qayrawan, and brought about another period of splendor for al-Qayrawan. However, when they declared their independence, the Fatimids in Cairo encouraged the Banu Hilal to invade Ifriqiya from the West and, in 1057, they utterly destroyed al-Qayrawan. In 1059 the population of Tunis swore allegiance to the Hammadid prince al-Nasir ibn Alnas, who was based in Bejaia (in modern-day Algeria), and this was the beginning of the rise of Tunis in power and population. This political upheaval could be what Peter the Deacon referred to as the reaction against Constantine that forced him to leave Africa. Whatever the case, it would not be a stretch to call the Arabic doctors and medical writers of al-Qayrawan also ‘Poeni’, and Constantine could just as easily have been a Poenus of al-Qayrawan as of Tunis (or of both).

Isaac, of course, was a Jew. Jews formed an important part of the population of al-Qayrawan which was a center of Talmudic and Halakhic scholarship until forced conversion in 1270. Another pupil of his was Dunash Ibn Tamim, another Jew—who was well known for his astronomical and cosmological learning, including, as it now seems, a cosmology attributed to Masha’allah in two Latin translations, called De orbe (‘On the World’).[8]

So what were these ‘Phoenician’ sources that Champier could have had access to? What were the works that Constantine translated?

A story goes that, as a kind of letter of introduction and witness to his competence, he presented the short Introduction to Medicine of Hunayn ibn Isḥaq to Alfano, archbishop of Salerno (1058-1085), when he arrived in Salerno.[9]This story may be apocryphal. The earliest version of the Isagoge is heavily Grecized, and could already have belonged to a South Italian trend of translating works on physics and astronomy from Greek and, when the Greek was not available, from Arabic, but giving the appearance that they were all translated from Greek. [10] Alfano himself (archbishop 1058-1085) translated Nemesius’s On the Nature of Man from Greek into Latin, whilst an unknown translator rendered parts of the same work from Arabic. In this case Constantine might have been responsible for making the text of the Isagoge less Greek. In any case it is an apt text from which to begin any account of the medical corpus translated from Arabic at the time .

The Isagoge gives, in very straightforward terms, the basic elements of Greco-Arabic humoral medicine. This is already clear from its opening:[11]

Medicine is divided into two parts, i.e. in theory and practice, of which theory is divided into three: into the observation of natural things, of non-natural things and those which are contrary to nature, from which the knowledge of health, illnesses and the neutral state arises… Natural things are seven in number, namely elements, mixtures, composite bodies, limbs, forces, actions, spirits. Others have added to these four others factors, namely ages, colours, appearances and the difference between male and female.[12]

This Isagoge was to form the first text of the corpus of Latin medical texts known as the Ars medicinae or Articella, which has survived in over 200 manuscripts, and incorporated texts translated from Greek as well as from Arabic: Hippocrates, Prognostics and Aphorisms (both from Arabic), Philaretus, On Pulses, and Theophilus, On Urines (both Byzantine Greek texts), and finishing with Galen’s Tegni or Ars parva (a general guide to medicine). But parallel to these texts, and exceeding them in quantity were translations that no modern scholar disputes belong to Constantine.

Constantine contributed several texts of the Qayrawani doctors, and a magnum opus which summates his life work and was probably left incomplete on his death.

The oldest of the Qayrawani corpus is a text by by Isḥaq ibn ‘Imran, On Melancholy, which deals with psychological diseases and their cure.[13] More substantial are the works of the Qayrawani doctor, Isḥaq Isra’ili.

An appropriate introduction is provided by Constantine’s preface to his translation of his work on urines:

Among Latin books I was able to find no author who published reliable and authoritative learning concerning urines. Hence I turned to the Arabic language, in which I found a wonderful book with information on this subject. This book I, Constantine the African, a monk of Montecassino, decided to translate into the Latin language, so that I might obtain a reward for my soul from my efforts and might widen the path for those beginning to learn about urines. This book has been collected and excerpted from ancient authors. From it one can easily approach the knowledge of urine, and also its divisions and indications. It was composed in Arabic by Isaac, the adoptive son of Solomon, and he divided it into ten parts.[14]

Urines were an important diagnostic aid. In the frontispiece of one manuscript of this text Constantine is depicted as a monk, receiving urine bottles from his patients (see Figure 2).

Here is Constantine, the monk of Montecassino, who is like the fount of this knowledge. He was well known for his judgements concerning all illnesses. In this book and in many other books he shows the true cure. Women come to him with <their> urine so that he can tell them what illness they are suffering from.[15]

The other texts of Isḥaq translated by Constantine were his books on fevers, and two books on healthy living: the Diaetae universales (‘General rules on health living’) and Diaetae particulares (‘Particular rules on health living’). These deal respectively with general effects on diets of age, gender, location and time of year, and specific foodstuffs.

The list of texts translated by Isḥaq’s pupil Ibn al-Jazzar includes works on healthy sexual intercourse (fi ’l-jimā‘, de coitu), on the stomach, on forgetfulness (fi ’l-nisyān, de oblivione)—this being written in response to a letter to Ibn al-Jazzar from somebody who had been suffering from ‘too much forgetfulness and inability to retain things as a result of too much reading’.[16]

The most important work of Ibn al-Jazzar that he translated, however, is the Zād al-musāfir, or ‘Guide to the Traveller’ (in Latin: Viaticum), whose full title is ‘Guide to the Traveller and Nourishment to the One who Stays at Home’ (… wa-qūt al-ḥāḍir). As the title is meant to imply, this is a self-help manual, for the patient who has no access to a doctor—or even to a pharmacist, for it provides ingredients for medicines which can easily be found in the locality of the patient. A famous example of its contents appears among the remedies for what we would call psychological diseases: in this case, lovesickness, which appeared also as a separate text (Liber de heros morbo—‘The Book on the Heroic Disease’).[17]

In case of sickness caused by excessive love, to prevent men from being submerged in excessive brooding, tempered and fragrant wine should be offered, and hearing various kinds of music, speaking with dear friends…

Rufus says: ‘’Sadness is taken away not only be wine drunk in moderation but also by other things like it, such as a temperate bath. Hence it is that when certain people enter a bath, they are inspired to sing. Therefore certain philosophers say that the sound is like the spirit, the wine is like the body of which the one is aided by the other.’[18]

The major work of Constantine the African, however, was his adaptation of the Kitāb or Kunnāsh al-malakī (‘The Royal Collection’), or Kāmil as-sinā’a aṭ-ṭibbiya (‘The Complete Book of the Medical Art’) of ‘Ali ibn al-‘Abbas al-Majusi al-Arrajani. Kunnāsh is originally a Syriac word indicating a collection of treatises, or a work of encyclopedic character, while Kāmil aṣ–ṣinā ‘at also indicates the comprehensiveness of the book. ‘Ali ibn al-‘Abbas lived during most of the tenth century (chronologically between the Arabic doctors Abu Bakr al-Razi and Ibn Sina). His nisbas indicate that he was a Zoroastrian from a Persian town situated between Shiraz and Ahwaz, and his work (his only work) was dedicated to the Buyid emir ‘Adud ad-Dawla who ruled in Shiraz and Baghdad from 949-83.[19] But the work must have spread westwards soon after its composition. It was certainly known in al-Andalus in 1068 when Ṣa’id al-Andalusi mentions the author and his book ‘as the best encyclopedia (kunnash) of medicine that he knows’.[20] So it is not surprising that Constantine should have got to know it in Ifriqiya. The Arabic text consists of ten books of theory and ten books of practice.

Constantine evidently regarded his version of this book as his most important work. He dedicated it to Abbot Desiderius in a florid style:

To the lord abbot of Montecassino, Desiderius, the most reverend father of fathers—nay rather the shining jewel of the whole ecclesiastical order, Constantine the African, although unworthy, nevertheless his monk,… <dedicates this work>.[21]

He gives it a name which picks up the ‘completeness’ in the Arabic title: ‘Pantegni’—a title concocted from two Greek words, meaning ‘all’ and ‘the art’, mirroring the Arabic title Kāmil aṣ-ṣinā‘a, and the book promises to include the ten books of theory and the ten books of practice which the Arabic has. In fact, this is not exactly what we have. Perhaps because of the shipwreck on Cape Palinurus, most of the early manuscripts have only the ten books of theory and two and a half books of the practice, while later manuscripts have completed the practice, following the order of subject matter of ‘Ali ibn al-‘Abbas’ text, but replacing the contents with those of a variety of other texts, some being translations by Constantine and his circle, others pre-Salernitan Latin medical texts. Thus, some short texts of Ibn al-Jazzar are included: On Leprosy, and On Degrees (of qualities in medicines). The Viaticum above all is used to fill up the Practica. Since some chapters come from the Liber aureus of Constantine’s pupil, Johannes Afflacius (a Muslim convert, also a monk at Montecassino), it may be that he (or other students) was responsible for adding some of the material. But the compilatory nature of the work is also implied by Constantine’s own words at the beginning of the Pantegni (Theorica): that he is the author in the sense of being the ‘coadunator’ of the whole work—somebody who puts together the whole thing from many books.[22]

‘Ali ibn al-‘Abbas’s own name does not appear in any of the manuscripts. Sometimes the work is attributed to the better-known ‘Rhazes’ (i.e. Abu Bakr Muhammad ibn Zakariyya ar-Razi).[23] But usually only Constantine’s name is given, and for this he was much criticized by later scholars, and especially by Stephen of Antioch who, in 1127, made a much more literal translation of the whole 20 books of the Kitāb al-malakī.[24] But, nevertheless, the Pantegni was very popular, surviving in over 100 manuscripts.

One reason for this popularity was 1) that it was the first fully comprehensive medical textbook, covering anatomy, surgery, regimen, diseases from head to toe, and fevers which afflicted the whole body, and finally giving a comprehensive list of materia medica and their properties (the pharmacy). Avicenna’s Canon was to fulfil the same roll and eventually to displace the Pantegni in the education of the doctor, but it wasn’t translated until a century later, by Gerard of Cremona. 2) That it was written in an accessible language. Constantine does not stick close to the Arabic, but paraphrases, abbreviates, avoids the excessive Greek terminology of earlier medical texts, and invents calques on the Arabic that are easy to understand (the already mentioned dura mater and pia mater), or retains the Arabic word, e.g. ṣifāq—‘peritoneum’, or part of the uterus–as siphac.[25] 3) The marketing strategy of the Benedictine monasteries, of which Montecassino was the hub. 4) The universalising of the relevance of medicine.

Constantine introduces ‘Ali ibn al-‘Abbas’s text with these words:

Since the whole of science has three principal parts—for all secular or divine letters are subject to logic, ethics or physics—many people have wondered to which of these parts ‘literal’ medicine should be subject. It is not put under logic alone, since neither invention nor judgement are predominant in it. It is not subject to physics alone, since it does not depend only on necessary arguments, whether they can be proved or not. It seems absurd to subject it to ethics alone, since it is not its intention to dispute about morals alone. But, since the doctor ought to be a dealer in natural and moral things, it is clear that, because it falls into all (categories), it must be subject to all different ways of thinking. Hence I, Constantine, weighing up the very great usefulness of this art, and running through the volumes of the Latins, when I saw them, in spite of their number, not to be sufficient for introducing <medicine>, I turned to our old or modern writers.[26]

The first chapter (where Constantine returns to ‘Ali ibn al-‘Abbas’s text) is a version of the Hippocratic Oath in which the one who wants to be a doctor should promise to honour his parents and his teacher, not to practice medicine for the sake of money, not to make poisons, not to learn how to abort unborn children, not to make amorous advances to the patient’s wife, maidservant or daughter, be ready to hear confessions from the patient which he would not dare to confess to his parents, and to read assiduously (and memorise the contents, in case you lose a book).

What is striking is that, when it came to printing the text, the work was no longer attributed to ‘Ali ibn al-‘Abbas, or even to Constantine, but to the Qayrawani doctor, himself, Isaac, and is printed alongside the other texts that are genuinely by Isaac, and Isaac is even given as the author of Ibn al-Jazzar’s Viaticum. The editor, Andrea Turino of Pescia, refused to publish these translations under the name of Constantine, because, he says, ‘everybody knows full well that Constantine stole these works’ (‘apud omnes liquido compertum sit id Constantini furtum esse’). Even when the original author cannot be recognized, we must suspect, Turino says, Constantine of theft, as is clear in the case of the Viaticum (‘ … Addidimus multa Constantini opuscula verentes et illa furta esse, ut de Viatico manifeste patet’); all the writings under his name fall under suspicion. As the title of the Pantegni Turino gives: ‘The book, Pantegni, of Isaac Isra’ili the adopted son of Solomon, king of Arabia: which Constantine the African, the monk of Montecassino, claimed was his own work’. [27]

This edition was printed by Barthélemi Trot in Lyons in 1515 (see Figure 3). It is endorsed by none other than Symphorien Champier, the citizen of Lyons, who, as the ‘illustrissimus philosophus’, addresses Andrea Turino with fulsome praise, for sweating over the emendation of the works of Isaac. When we return to the Practica nova (‘The New Practice’), published two years later, we find that Champier repeats his arguments for the authorship of Isaac.[28] And we can make sense of the quotation of the passage of the Viaticum as being by ‘Constantinus sive Isaac’ (‘Constantine or Isaac’). Champier gives the reference in the margin: ‘Isaac or Constantine in Isaac, the fourth <book> of the Viaticum chapter 14’ (‘Isaac sive Constantinus in Isaac .iiii. Viatici caput .xiiii.’; see Figure 1).

While there is some appropriateness in calling both Constantine and Isaac ‘Poeni’ there remains the question as to what led Symphorien Champier to adopt this name. Did he mean to suggest something distinctive about the contribution of the ‘Poeni’, as opposed to the ‘Arabes’—a different geographical origin, or a different kind of medicine? This seems unlikely, since he always groups the ‘Poeni’ and ‘Arabes’ together. But it might also be possible to see the reference to ‘Poeni’ in the light of a Classicizing tendency both in the eleventh-twelfth century and in the Renaissance. To openly declare in the late eleventh that one’s work was taken from the Saracens would not, perhaps, have been the best way to advertise its value, at a time when Christians were in open conflict with Muslims in Spain and Sicily and the First Crusade was just about to begin. in the late eleventh. But to imply that Constantine the African’s itinerary was similar to that of Aeneas restored some respectability to what he achieved. Just as Aeneas brought the benefits of Phoenician royal culture from Carthage to Rome and founded Roman civilisation, so Constantine brought medicine (including a ‘royal’ book) from Carthage to Salerno and founded Western medicine.

Bibliography and References to Burnett

Printed books

Bloch, H., Montecassino in the Middle Ages, 3 vols, Rome, 1986. An incredibly rich description of the Benedictine Abbey of Montecassino where the first corpus of Arabic medical texts was translated into Latin in the late eleventh century, and from where these translations were diffused throughout Western Europe.

Burnett, C., ‘European Knowledge of Arabic Texts Referring to Music: Some New Material’, Early Music Theory, 12, 1993, pp. 1-17. This includes a discussion of music therapy taken from Arabic medical writings.

Burnett, C., ‘Physics before the Physics: Early Translations from Arabic of Texts concerning Nature in MSS British Library, Additional 22719 and Cotton Galba E IV’, Medioevo, 27, 2002, pp. 53–109. Evidence that Constantine the African arrived in Southern Italy at a time when there was already a great interest in learning from the Arabs.

Burnett, C.,‘The Legend of Constantine the African’, in The Medieval Legends of Philosophers and Scholars, Micrologus 21, 2013, pp. 277-94. On the reputation of Constantine the African throughout the centuries.

Burnett, C. and D. Jacquart (eds), Constantine the African and ‘Ali ibn al-‘Abbas al-Maǧusi: the Pantegni and Related Texts, Leiden, 1994. A collection of articles on the various aspects of the transmission and impact of the earliest corpus of Arabic medical texts in Europe, of which the major one was the Royal Collection (Kunnāsh al-malakī) of ‘Ali ibn al-‘Abbas al-Maǧusi.

Grant, E., A Source Book for Medieval Science, Cambidge, MA, 1974. A valuable resource for English translations of key texts in medieval science, including several from (ultimately) Arabic sources.

Hasse, D.N., Success and Suppression: Arabic Sciences and Philosophy in the Renaissance, Cambridge MA, 2016, pp. 42-45. This is the most up-to-date and fullest account of the impact of Arabic learning in the Renaissance and Early Modern period, both the positive aspects that contributed to developments of science, technology and thought in the West, and the negative reactions to Arabic influences.

Jacquart, D. and F. Micheau, La Médecine Arabe et l’Occident Médiéval, Paris, 1990. An authoritative account of the transmission of Arabic medicine to Western Europe in the Middle Ages, including a section on Qayrawan (pp. 107-18).

Newton, F., ‘Arabic Medicine in Italy: Constantine the African,’ in Mediterranean Passages, from Dido to Derrida, eds Miriam Cooke, Erdağ Göknar, and Grant Parker, Chapel Hill NC, 2008, pp. 115-121. Just one of several works on Constantine the African and Montecassino by a leading expert in the field.

[17] M. Wack, ‘‘Alī ibn al-‘Abbās al-Maǧūsī and Constantine on Love, and the Evolution of the Practica Pantegni,’ in Constantine the African, pp. 161-202. ‘Heroic’ plays on the double meaning of ‘heroicus’: ‘belong to passionate love’ (erōs) and ‘heroic’.